Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics

Fowler, Stephen J.; French, Joshua P.; Screaton, Nicholas; Foweraker, Juliet; Condliffe, Alison M.; Haworth, Charles; Exley, Andrew; Bilton, Diana

doi:10.1183/09031936.06.00149805

Cited by 146 publications

(100 citation statements)

References 21 publications

(27 reference statements)

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“…Our analysis in the validation cohorts where antibiotics were widely used suggests this did not significantly confound the analysis. Only four patients in the derivation study were excluded due to NTM, as this is an infrequent underlying cause in UK centers (16,28). In contrast, very high rates of NTM have been reported in the United States registry (29).…”

Section: Discussionmentioning

confidence: 99%

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

816

836

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Rationale: There are no risk stratification tools for morbidity and mortality in bronchiectasis. Identifying patients at risk of exacerbations, hospital admissions, and mortality is vital for future research.Objectives: This study describes the derivation and validation of the Bronchiectasis Severity Index (BSI).Methods: Derivation of the BSI used data from a prospective cohort study (Edinburgh, UK, 2008 enrolling 608 patients. Cox proportional hazard regression was used to identify independent predictors of mortality and hospitalization over 4-year follow-up. The score was validated in independent cohorts from Dundee, UK (n = 218); Leuven, Belgium (n = 253); Monza, Italy (n = 105); and Newcastle, UK (n = 126).Measurements and Main Results: Independent predictors of future hospitalization were prior hospital admissions, Medical Research Council dyspnea score greater than or equal to 4, FEV 1 , 30% predicted, Pseudomonas aeruginosa colonization, colonization with other pathogenic organisms, and three or more lobes involved on high-resolution computed tomography. Independent predictors of mortality were older age, low FEV 1 , lower body mass index, prior hospitalization, and three or more exacerbations in the year before the study. The derived BSI predicted mortality and hospitalization: area under the receiver operator characteristic curve (AUC) 0.80 (95% confidence interval, 0.74-0.86) for mortality and AUC 0.88 (95% confidence interval, 0.84-0.91) for hospitalization, respectively.There was a clear difference in exacerbation frequency and quality of life using the St. George's Respiratory Questionnaire between patients classified as low, intermediate, and high risk by the score (P , 0.0001 for all comparisons). In the validation cohorts, the AUC for mortality ranged from 0.81 to 0.84 and for hospitalization from 0.80 to 0.88. Conclusions:The BSI is a useful clinical predictive tool that identifies patients at risk of future mortality, hospitalization, and exacerbations across healthcare systems.

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Section: Discussionmentioning

confidence: 99%

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Chalmers

Goeminne²,

Aliberti

et al. 2014

Am J Respir Crit Care Med

816

836

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“…According to the literature, the incidence of NTMLD in patients with cystic fibrosis amounts to approximately 3% [21], in patients with bronchiectasis 2-3% [22,23], and in persons with past pulmonary tuberculosis approximately 2% [24].…”

Section: Discussionmentioning

confidence: 99%

Non-Tuberculous Mycobacterial Lung Disease (NTMLD) in Patients with Chronic Thromboembolic Pulmonary Hypertension and Idiopathic Pulmonary Arterial Hypertension

Wilińska¹,

Oniszh²,

Augustynowicz–Kopeć³

et al. 2014

Advances in Respiratory Medicine

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Non-tuberculous mycobacterial lung disease (NTMLD) in patients with chronic thromboembolic pulmonary hypertension and idiopathic pulmonary arterial hypertensionMikobakterioza płuc u chorych na nadciśnienie płucne zakrzepowo-zatorowe i idiopatyczne tętnicze nadciśnienie płucneThe authors declare no financial disclosure Abstract Introduction: Non-tuberculous mycobacterial lung diseases (NTMLD) occur rarely and are diagnosed mainly in patients belonging to risk groups. Pulmonary hypertension (PH) has not been recognised as a risk factor for NTMLD yet. The aim of the study was to analyse the clinical course and predisposing factors of NTMLD recognised in our centre between 2002 and 2012 in patients with chronic thromboembolic pulmonary hypertension (CTEPH) and idiopathic pulmonary arterial hypertension (IPAH). Material and methods: Thirteen patients (10 -CTEPH, 3 -IPAH) entered the study. PH was recognised during right heart catheterisation. Median value of mean pulmonary artery pressure (mPAP) was 49 mm Hg (39-65 mm Hg). NTMLD was diagnosed according to ATS guidelines (2007). Results: M. kansasii was the most frequent pathogen. Most patients complained of the exaggeration of dyspnoea and productive cough. Computed tomography of the chest with angiography revealed infiltrations with cavitation in seven patients and cavities surrounded by micronodules in six patients. In all CTEPH patients, NTMLD developed in the hypoperfused lung areas. No parenchymal abnormalities preceded the development of NTMLD. After diagnosis all of the patients received antituberculous treatment; in 12/13 improvement was achieved. By the end of March 2014 seven patients died due to right heart insufficiency, no deaths due to NTMLD were noted. Conclusions: NTMLD should be suspected in patients with CTEPH or IPAH, presenting with productive cough and a new pulmonary infiltrate with cavitation. In patients with CTEPH, special attention should be paid to a new cavitary lesions without accompanying thrombus in the artery supplying the area. High mPAP (CTEPH/IPAH) and hypoperfusion (CTEPH) are predisposing to NTMLD.

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“…In this study, 44% of the patients with NTM also had bronchiectasis (29). The frequency of NTM isolation in non-CF bronchiectasis has varied from 2 to 30% (Table 1); Mycobacterium avium complex (MAC) is the most common isolate, followed by rapidly growing mycobacteria (30)(31)(32)(33)(34). Thus, the overlap between bronchiectasis and NTM infections is significant, and both conditions appear to be increasingly prevalent.…”

Section: ])mentioning

confidence: 99%

Infections in “Noninfectious” Lung Diseases

et al. 2014

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Many chronic pulmonary diseases, including those that are not primarily infectious in etiology, have some aspects of their pathogenesis that are influenced by infectious organisms. Microorganisms may contribute to chronic lung diseases, either directly (i.e., overt infection) or indirectly, via the amplification of inflammatory pathways that are critical to host defense. As techniques for detecting and characterizing microorganisms have advanced, investigations of both infecting and colonizing organisms have yielded new insights into mechanisms of pulmonary disease. In addition, changes in patterns of infection and microbial resistance have important implications for treatment. Examples of these infectious-pulmonary associations, including Haemophilus influenzae infection and chronic obstructive pulmonary disease, nontuberculous mycobacteria and bronchiectasis, and human immunodeficiency virus and obstructive lung disease, are reviewed.

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Nontuberculous mycobacteria in bronchiectasis: prevalence and patient characteristics

Cited by 146 publications

References 21 publications

The Bronchiectasis Severity Index. An International Derivation and Validation Study

The Bronchiectasis Severity Index. An International Derivation and Validation Study

Non-Tuberculous Mycobacterial Lung Disease (NTMLD) in Patients with Chronic Thromboembolic Pulmonary Hypertension and Idiopathic Pulmonary Arterial Hypertension

Infections in “Noninfectious” Lung Diseases

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